High grade squamous intraepithelial lesion of the cervix

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Dear OncoLink "Ask The Experts," I have just learned that I have a high grade cell change, following a Pap test. I am going for a colposcopy in a few weeks. Does this mean that I have cancer? How can they tell if it is not in the uterus too? Will a colposcopy be able to rule out uterine and ovarian cancer as well as cervical cancer?

Christina S. Chu, MD, Assistant Professor of the Division of Gynecologic Oncology at the University of Pennsylvania Health System, responds:

The diagnosis of high grade squamous intraepithelial lesion (or HGSIL) on a Pap test means the presence of precancerous cells, not cancer. In lay terms, precancerous cells may be mild, moderate, or severe. The designation of HGSIL refers to the presence of moderate or severe pre-cancer. Colposcopy is an important step in correct diagnosis, since Pap tests are only meant to be screening tests. At the time of your colposcopy, your physician will examine your cervix and biopsy any abnormal appearing areas. These biopsies will confirm whether or not you have precancerous cells present on your cervix. Most moderate and severe pre-cancers can be adequately treated with an excisional biopsy such as a LEEP or a cone to prevent future progression to actual cancer.

Pap tests and colposcopy are not designed to check for uterine or endometrial cancer. However, please understand that having precancerous cells on your Pap test does not predispose you to having uterine or endometrial cancer. These are separate entities with separate risk factors. Women who have normal, regular periods without intermenstrual bleeding, and post-menopausal women who have no signs of vaginal bleeding generally do not need to be checked for uterine or endometrial cancer since the vast majority of patients with these cancers exhibit some kind of abnormal bleeding pattern.

Sep 9, 2011 - Liquid-based cytology detects cervical cancer recurrence in about one-third of patients treated for cervical cancer; and, in the absence of any visible lesions, colposcopy is not indicated for follow-up of patients with atypical squamous cells of uncertain significance or low-grade squamous intraepithelial lesions, unless abnormalities persist, according to a study published in the September issue of Obstetrics & Gynecology.